1. Field of the Invention
The present invention generally relates to the reconnection of the urethra and bladder after a radical retropubic prostatectomy. Specifically, the invention relates to a method and device for performing a urethral-vesicle anastomosis.
2. Description of the Related Art
In a radical retropubic prostatectomy, the surgeon removes all or most of the patient""s prostate. Because the urethra travels through the prostate immediately before reaching the bladder, the upper part of the urethra is removed in the surgery. In order to restore proper urinary functions, the bladder and the urethra must be reconnected.
Heretofore, surgeons would execute painstaking suturing operations with tiny, fine needles to reconnect these anatomical bodies. It has been found that the use of sutures for this purpose has caused certain problems in recovery. These problems include necrosis of the sutured tissues, stricture of the urethra which impedes the flow of fluid through it, and a urethra-bladder connection which is not fluid-tight. In addition, when suturing the urethra to the bladder the surgeon often inadvertently pierces the nearby neurovascular bundle, which can cause incontinence or impotence.
The suturing process itself has also been found to be cumbersome, requiring the surgeon to grasp and stretch the bladder and urethra together before making the fine sutures.
With radical retropubic prostatectomies becoming more common, a quicker and simpler way to reconnect the bladder and the urethra is needed.
One aspect of the present invention is an improved method for the anastomosis of the urethra to the bladder following a prostatectomy.
A further aspect of the present invention is an anastomosis procedure that eliminates the use of sutures in the urethra-bladder junction.
A still further aspect of the present invention is an anastomosis procedure with an improved means of grasping the urethra and bladder, bringing them together and holding them for the connection process.
A method and device are provided for the anastomosis of the urethra and bladder after radical retropubic prostatectomy. The surgeon inserts a trocar into the urethra and secures the bladder to the trocar with an external ring, or, alternatively, with at least one prong associated with the trocar. The surgeon then inserts a sheath into the bladder and secures the bladder to the sheath with at least one prong. The trocar and the sheath are then advanced toward each other, and fit together in an end-to-end fashion. When the urethral tissue and the bladder tissue are in close proximity, the urethra and the bladder are reconnected using at least one clip. The urethra is secured to the bladder
In accordance with one preferred embodiment, a method is provided for securing the urethra to the bladder of a patient. The method comprises the steps of inserting a first approximation device into the urethra, securing the urethra to the first approximation devices inserting a second approximation device into the bladder and securing the bladder to the second approximation device. The method further comprises the step of advancing the second approximation device toward the first approximation device so that a distal end of the urethra comes in close proximity to a distal end of the bladder. The final step of the method comprises securing the urethra to the bladder.
In accordance with yet another preferred embodiment, a method for securing the urethra to the bladder of a patient comprises the steps of inserting a first approximation device into the urethra, securing the urethra to the first approximation device, inserting a second approximation device into the bladder and securing the bladder to the second approximation device. The method further comprises advancing the first approximation device and the second approximation device toward one another so that a distal end of the urethra comes in close proximity to a distal end of the bladder. Finally, the urethra is secured to the bladder.
In accordance with still another preferred embodiment, there is provided a system for securing the urethra of a patient to the bladder of the patient. This system comprises a first approximation device adapted to be inserted into the urethra of the patient and a ring. The ring is suitable for placement on a exterior of the urethra for securing the urethra to the first approximation device. The system further comprises a second approximation device adapted to be inserted into the bladder. The second approximation device has at least one prong on a cannula of the second approximation device. The prong secures the second approximation device to the bladder. The system further comprises at least one clip. The clip is suitable to secure the urethra to the bladder once the urethra and bladder are within close proximity.
In accordance with still another preferred embodiment, there is provided a system for securing the urethra of a patient to the bladder of the patient. The system comprises of first approximation device that has a generally rigid cannula and at least one prong. The prong is moveable from a retracted position to an extended position on a exterior surface of the cannula to secure the urethra to the first approximation device. The system also comprises a second approximation device that has a generally rigid cannula and at least one prong. The prong is moveable from a retracted position to an extended position on an exterior surface of the cannula to secure the bladder to the second approximation device.